Case study: Managing filler migration and poor placement with topical and injectable hyaluronidase and filler multilayering

The lips and lower face are highly dynamic and complex facial areas which vary greatly between individuals. As a result, there is no ‘one size fits all’ treatment protocol that can provide harmony to this area. We do indeed use concepts of proportions and ratios to approximate aesthetically pleasing targets for treatment, however idealising proportions alone does not necessarily result in ideal enhancement and does not consider distortion of features on dynamism (Farkas et al, 1985). To truly harmonise facial features and provide natural results, careful assessment of both the static and dynamic facial presentation is required (Trévidic et al, 2022). This case study explores the assessment, planning and treatment of lower face disharmony with a focus on correction of misplaced filler in the lips and lower face.

A young woman in her 20s attended as she was originally concerned about the appearance of her under eyes. She felt they looked dark and sunken. She had never had this area treated; however she had previously had lip filler a year prior with a medical professional. Medically, she was fit and well with no known allergies. Her only prior aesthetic treatments had been 1ml lip filler and 1ml chin filler over a year ago.